Provider Demographics
NPI:1659952216
Name:DOWNTOWN FOOT CLINIC, LLC
Entity Type:Organization
Organization Name:DOWNTOWN FOOT CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LANTSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-223-3380
Mailing Address - Street 1:610 SW ALDER ST STE 506
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3606
Mailing Address - Country:US
Mailing Address - Phone:503-223-3380
Mailing Address - Fax:503-223-2522
Practice Address - Street 1:610 SW ALDER ST STE 506
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3606
Practice Address - Country:US
Practice Address - Phone:503-223-3380
Practice Address - Fax:503-223-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric